Evidence suggests that altered metabolism can have an important role in the development of HIV‑associated wasting
What is HIV‑associated wasting?
Who may be at risk?
HIV‑associated wasting is a serious, underdiagnosed condition that may impact a range of patients living with HIV, including those who are well controlled on ART.7,8
HIV‑associated wasting may affect a range of patients 2,7-9
Many of your patients may be at risk for HIV‑associated wasting, including:
- Newly diagnosed patients
- HIV Long-Term Survivors
- HIV‑positive patients with normal CD4 counts and controlled viral loads
- Patients on ART who fail to gain weight
- Patients on ART with acute infection
- Patients with advanced HIV disease
- Poor virologic responders
- Patients who have been nonadherent to ART
More men experience HIV‑associated wasting, but it can occur in women, too.
Many factors contribute to HIV‑associated wasting2,5
The exact causes of HIV‑associated wasting remain unknown and are unique to every patient. HIV‑associated wasting is a diagnosis of exclusion. There are several factors associated with altered metabolism and/or reduced caloric intake that may result in unintentional weight loss in your patients living with HIV.
Opportunistic infections (OIs)7,11-13
- OIs related to HIV have been shown to increase the risk of unintentional weight loss and may lead to metabolic changes
- Persistent HIV infection leads to long-term immune activation and chronic inflammation, even in HIV‑positive patients on ART with undetectable viral loads
- In patients living with HIV, this chronic, systemic inflammatory response leads to the ongoing loss of LBM, which may lead to unintentional weight loss
- Dysregulation of metabolic pathways can result in inappropriate depletion of LBM, body weight, and a relative preservation of body fat
- In HIV‑positive patients, endocrine dysfunction is a common clinical manifestation
- There is a high correlation between loss of LBM and hypogonadism in HIV‑positive men who are on ART
- Among HIV‑positive women, decreased levels of free testosterone are also significantly associated with HIV‑associated wasting
Growth hormone (GH) resistance 2,9,17,19
- GH secretion and action are affected by nutritional status and changes in body composition
- In HIV‑associated wasting patients, a pattern of acquired GH resistance is seen, with increased GH and simultaneously decreased concentrations of insulin growth factor-1 (IGF-1)
- The GH/IGF-1 axis is one of the regulators of muscle protein metabolism that is altered in patients with HIV‑associated wasting
Are your patients experiencing symptoms of HIV‑associated wasting?
- Serostim® (somatropin) for injection [prescribing information]. Rockland, MA: EMD Serono, Inc.
- Gelato M, McNurlan M, Freedland E. Role of recombinant human growth hormone in HIV‑associated wasting and cachexia: pathophysiology and rationale for treatment. Clin Ther. 2007;29(11):2269-2288.
- Dudgeon WD, Phillips KD, Carson JA, Brewer RB, Durstine JL, Hand GA. Counteracting muscle wasting in HIV‑infected individuals. HIV Med. 2006;7(5):299-310.
- Perry CM, Wagstaff AJ. Recombinant mammalian cell-derived somatropin: a review of its pharmacological properties and therapeutic potential in the management of wasting associated with HIV infection. BioDrugs. 1997;8(5):394-414.
- Grinspoon S, Mulligan K; for the Department of Health and Human Services Working Group on the Prevention and Treatment of Wasting and Weight Loss. Weight loss and wasting in patients infected with human immunodeficiency virus. Clin Infec Dis. 2003;36(Suppl 2):S69-S78.
- Grinspoon S, Corcoran C, Rosenthal D, et al. Quantitative assessment of cross-sectional muscle area, functional status, and muscle strength in men with the acquired immunodeficiency syndrome wasting syndrome. J Clin Endocrinol Metab. 1999;84(1):201-206.
- Wasserman P, Segal-Maurer S, Wehbeh W, Rubin DS. Wasting disease, chronic immune activation, and inflammation in the HIV‑infected patient. Top Clin Nutr. 2011;26(1):14-28.
- Erlandson KM, Li X, Abraham AG, et al. Long-term impact of HIV wasting on physical function. AIDS. 2016;30(3):445-454.
- Falutz J. Growth hormone and HIV infection: contribution to disease manifestations and clinical implications. Best Pract Res Clin Endocrinol Metab. 2011;25(3):517-529.
- Macallan DC. Wasting in HIV infection and AIDS. J Nutr. 1999;129(1S Suppl):238S-242S.
- Jacobson DL, Bica I, Knox TA, et al. Difficulty swallowing and lack of receipt of highly active antiretroviral therapy predict acute weight loss in human immunodeficiency virus disease. Clin Infect Dis. 2003;37(10):1349-1356.
- Chu C, Selwyn PA. Complications of HIV infection: a systems-based approach. Am Fam Physician. 2011;83(4):395-406.
- Melchior JC, Raguin G, Boulier A, et al. Resting energy expenditure in human immunodeficiency virus-infected patients: comparison between patients with and without secondary infections. Am J Clin Nutr. 1993;57(5):614-619.
- Deeks SG, Tracy R, Douek DC. Systemic effects of inflammation on health during chronic HIV infection. Immunity. 2013;39(4):633-645.
- Chang HR, Dulloo AG, Bistrian BR. Role of cytokines in AIDS wasting. Nutrition. 1998;14(11-12):853-863.
- Castaneda C. Muscle wasting and protein metabolism. J Anim Sci. 2002;80(suppl 2):E98-E105.
- Grinspoon S, Corcoran C, Lee K, et al. Loss of lean body and muscle mass correlates with androgen levels in hypogonadal men with acquired immunodeficiency syndrome and wasting. J Clin Endocrinol Metab. 1996;81(11):4051-4058.
- Grinspoon S, Corcoran C, Miller K, et al. Body composition and endocrine function in women with acquired immunodeficiency syndrome wasting. J Clin Endocrinol Metab. 1997;82(5):1332-1337.
- Melmed S. Disorders of the anterior pituitary and hypothalamus. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 19th ed. McGraw-Hill; 2015.